Provider Demographics
NPI:1902852783
Name:FIELDS, GREGORY IAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:IAN
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 J ST
Mailing Address - Street 2:SUITE 435
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-425-3177
Mailing Address - Fax:
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:SUITE 435
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-425-3177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL161132Medicare PIN
CAZZZ17916ZMedicare ID - Type Unspecified
ZZZ04183ZMedicare PIN